For healthcare professionals
PESI score calculator (PESI and sPESI)
The Pulmonary Embolism Severity Index (PESI) sorts adults with a confirmed acute pulmonary embolism into five classes of 30-day mortality from 11 findings at presentation. The simplified PESI (sPESI) uses six of them, one point each. This calculator works out both from the same answers. It is written for clinicians and is not a diagnosis.
Findings at presentation
For an adult with a confirmed acute pulmonary embolism. Answer each item. Nothing you enter leaves this page.
What you will see
The PESI total and class (I to V) with the 30-day mortality range for that class, and the simplified PESI from 0 to 6 with the items that scored.
Educational only, not medical advice. Not a diagnosis and not a treatment decision.
Source
Aujesky D and colleagues, Am J Respir Crit Care Med 2005 (PESI), and Jiménez D and colleagues, Arch Intern Med 2010 (sPESI): the classes and 30-day mortality figures. Points as printed in Table 1 of Luijten and colleagues, 2024 (open access); class cut points as set out by Shafiq and colleagues, 2015 (open access). The tests check every point value, every class boundary and the sPESI items.
Validated in
PESI: built from 15,531 hospital discharges for pulmonary embolism at 186 Pennsylvania hospitals, split into derivation and internal validation samples, and checked in 221 inpatients from Switzerland and France (Aujesky 2005). sPESI: built in 995 outpatients with acute symptomatic pulmonary embolism in Spain and checked in 7106 outpatients in the multinational RIETE registry (Jiménez 2010).
Limits
Both scores are for adults with a confirmed acute pulmonary embolism. They estimate the risk of death from any cause within 30 days; they do not measure right ventricular strain or the size of the clot, and they do not cover other reasons a patient may need hospital care, such as bleeding risk. The mortality figures come from older cohorts and may not match patients seen today.
PESI and sPESI scoring
The PESI starts from the patient's age in years and adds points for each finding present. The sPESI gives 1 point for each of six items (Luijten 2024).
| Finding | PESI points | sPESI points |
|---|---|---|
| Age | Age in years | 1 if over 80 |
| Male sex | +10 | None |
| History of cancer | +30 | 1 |
| History of heart failure | +10 | 1 (chronic cardiopulmonary disease, counted once) |
| History of chronic lung disease | +10 | |
| Heart rate 110/min or more | +20 | 1 |
| Systolic blood pressure under 100 mmHg | +30 | 1 |
| Respiratory rate 30/min or more | +20 | None |
| Temperature under 36 °C | +20 | None |
| Altered mental status (disorientation, lethargy, stupor or coma) | +60 | None |
| Arterial oxygen saturation under 90% | +20 | 1 |
Some reviews print the respiratory rate item as more than 30 breaths per minute; this calculator follows the "30 or more" wording of the table it cites (Luijten 2024).
PESI classes and 30-day mortality
The total places the patient in one of five classes (Shafiq 2015). The mortality column gives the range of 30-day mortality seen in each class across the derivation and validation samples of the original study (Aujesky 2005).
| Class | PESI total | 30-day mortality |
|---|---|---|
| I | 65 or less | 0 to 1.6% |
| II | 66 to 85 | 1.7 to 3.5% |
| III | 86 to 105 | 3.2 to 7.1% |
| IV | 106 to 125 | 4.0 to 11.4% |
| V | over 125 | 10.0 to 24.5% |
Classes I and II are grouped as low risk in the studies cited here (Shafiq 2015) (Luijten 2024).
Simplified PESI results
An sPESI of 0 is low risk and 1 or more is high risk. In the Spanish derivation cohort, the 30.7% of patients with an sPESI of 0 had a 30-day mortality of 1.0%, against 10.9% in those with 1 or more. In the RIETE validation cohort the figures were 1.1% and 8.9%. The sPESI predicted death about as well as the full PESI (Jiménez 2010).
Where the scores are used
The authors meant the PESI to help guide the initial intensity of treatment (Aujesky 2005). A 2024 pooled analysis of home-treatment studies included studies that selected patients for treatment at home with PESI class I or II, or an sPESI of 0, and others that used the Hestia checklist instead (Luijten 2024). Current guidelines and local pathways should guide those decisions.
Related tools
The PESI comes after the diagnosis. Before it, the Wells score for PE sets the pretest probability of pulmonary embolism, and the PERC rule calculator checks the 8 rule-out criteria in patients whose probability is already low. For a swollen or painful leg, see the Wells score for DVT. For other clinician scores on this site, see the HEART score calculator for chest pain and the qSOFA score calculator for suspected infection.
Sources
- Aujesky D, Obrosky DS, Stone RA, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172(8):1041-1046. doi:10.1164/rccm.200506-862OC. PMID 16020800. Abstract (15,531 discharges from 186 Pennsylvania hospitals, external validation in 221 inpatients from Switzerland and France, 11 characteristics, five classes and the 30-day mortality range for each class). pubmed.ncbi.nlm.nih.gov/16020800/
- Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199. PMID 20696966. Abstract (Spanish derivation cohort of 995 outpatients, RIETE validation cohort of 7106, the six sPESI variables and 30-day mortality for low and high risk). pubmed.ncbi.nlm.nih.gov/20696966/
- Luijten D, Douillet D, Luijken K, et al. Safety of treating acute pulmonary embolism at home: an individual patient data meta-analysis. Eur Heart J. 2024;45(32):2933-2950. doi:10.1093/eurheartj/ehae378. PMID 38993086. Open access (CC BY 4.0). Table 1 (PESI and sPESI points, PESI class I 0-65 and II 66-85, sPESI 0 for home treatment). pmc.ncbi.nlm.nih.gov/articles/PMC11335374/
- Shafiq A, Lodhi H, Ahmed Z, Bajwa A. Is the Pulmonary Embolism Severity Index being routinely used in clinical practice? Thrombosis. 2015;2015:175357. doi:10.1155/2015/175357. PMID 26294971. Open access (CC BY). Methods 2.2 (PESI class cut points I to V). pmc.ncbi.nlm.nih.gov/articles/PMC4532959/
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-01. Spotted an error? See About.